Monday, June 15, 2009

A Healthy Debate

Lately, President Obama has been traveling around the country proclaiming that he has the solution to the nation's health care crisis. This may or may not be true. What is certainly true is that we have a health care crisis.

We pay the most per capita of any country on earth for medical services. Yet, our system was ranked 37th best by the World Health Organization . While the results of this survey have been challenged, no matter whether we're number 37 or somewhere higher, it's clear that we're not exactly getting our money's worth when it comes to health care.

The people who have insurance have no idea what health care really costs as they are sheltered from the actual charges. The poor who have no health insurance are protected by laws that demand they be taken care of independent of their ability to pay (as long as they wait long enough before seeking care in a hospital emergency room to get really, really sick). The ones who are really shafted in our system are those who have no health insurance, but do have the ability to pay (or file for bankruptcy). They are charged outlandish fees for every procedure.

I can share one example from my own personal experience. I had an out-patient procedure to break up kidney stones. I was in the hospital for a grand total of four hours. The procedure itself took about 30 minutes. The bill was more than $56,000. Because I had insurance, I paid about $1000 and the insurance company paid about $1000. But if I didn't have insurance, I would have been on the hook for the full amount. This is insane.

I'm sure you've heard similar stories. The bottom line is that things are seriously out of whack.

I have no clue if a government run health system would be better. I suspect it would not. What is clear is that the present system which focuses on pay for services provided has exactly the wrong incentives. Instead of encouraging expensive procedures after we get sick, the system should reward doctors who keep you healthy in the first place. But if your doctor tries to provide preventive care, Medicare, today's model of a government-run health system, will not pay for it.

I have lived in Countries with "National health Systems" some are good and some are bad and getting worse, e.g. Canada. I know where I want to be if I am sick, right here in USA.Medicare, from my two years of experience, is a good system it is short however on some preventive and investigative issues like annual check-ups. It would not take a major change to include these and I believe the extra costs would be more than off-set by reduced "emergency care".

Don't know if you saw this health care related article in the New Yorker a while back, I thought it to be quite illuminating http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?printable=true

Ex-Silicon Guy, thanks for the reference. The New Yorker article points out that money spent doesn't correlate with patient outcomes. And whether we have a government run system is not the question. Rather, the author recommends an HMO-like model with physicians forming teams to treat patients most cost effectively.

United States: Private Health Care, GDP $36,300, Life Expectancy 77, Cost - we only hear the horror stories, so I am not in a position to say.

So looking at all the places I have been I see no correlation between what is paid and how long a person lives - which ultimately is a gauge on how well the health care system must be working - essentially if you die, there is something wrong with the system.

Cuba has a life expectancy similar the the US - and they have extremely basic technology. They also have universal access (dare I say a benefit of the socialist system?)

Egypt has good technology - and they have a much lower life expectancy (the poor simply cannot afford active treatment - I know when I had a little dysentery it was going to cost me US$5000 just to see a doctor).

So high tech is not the key to long term survival, and access to care needs to be universal to ensure long term survival.

So the questions are- how much do we need to spend?- how do we get universal access?- how do you get preventive care?

Thanks for the opportunity to vent again... and no mention of bodily fluids this time :)